‘Pearls of Wisdom’ for Leadership and Success in Academic Medicine Gathered Over a 35-Year Career

Dr. Hayes, ASCO President 2016–2017, is Professor of Internal Medicine; Stuart B. Padnos Professor in Breast Cancer; and Clinical Director of the Breast Oncology Program at the University of Michigan Comprehensive Cancer Center, Ann Arbor.

AS I COMPLETE my 3-year term as ASCO President, I am stimulated to relay thoughts on “pearls of wisdom” I have picked up over the years about leadership and success, particularly in academic medicine. Those of you who follow the commentaries of Joseph V. Simone, MD, will immediately ascertain that this sort of navel-gazing is not original. Indeed, Simone’s Maxims, first published in 1999 and now updated and expanded,1 has been one of the most read, and inspiring, tomes in my library for nearly 2 decades.

I have been educated, trained, or worked as a faculty member in 5 different institutions over the past 35 years. I have witnessed visionary leadership and incredibly successful individuals in science, education, and clinical care. However, I have also had the opposite experience. The pearls of wisdom listed here are mostly my observations of those who have trained or mentored me over the years and the impact their influence has had on my career.

I have tried to cite the specific author for each “pearl” but may at times have it incorrect or the author may be unknown to me. Regardless, I hope these 35 statements about leadership are helpful to those considering a career in academia or to those who have themselves become leaders in the field of oncology.

Leadership

1. Leaders lead. Credit Allen S. Lichter, MD, FASCO, former ASCO Chief Executive Officer. What does he mean by that? Know what you want, have vision, listen to others, and seek advice, but ultimately—especially in a tense situation—take the reins and lead.

2. Make the call. Credit unknown, but the point is analogous to a call from a baseball umpire: Look at the situation in question, assess it, seek advice from others, sum it up in your mind, be confident of what you saw and what you think should be done, and then “make the call.” Indecision can paralyze a program or institution and lead to divisiveness and chaos. Sometimes you will make the wrong call, but don’t reverse your decision unless you are sure it was a mistake.

3. Plan for a Rolls Royce, but build what you can afford. Credit me, through a massive amount of advice from many of my former mentors. This pearl includes several elements, including:

Vision. What do you want your program, division, department, cancer center, or society to look like in 5 years? Too often, leaders let their program grow by diffusion or paths of least resistance. That’s not always bad—some of my best recruits came to me by accident—but, generally, it’s better to have an idea of what you want and then go out and get it.

A strategic plan. Dream big. Put your idea on paper. You do not have to show it to anyone, but have it where you can access it when you are ready to implement your plan.

Prioritization. Know what you can and cannot do, and understand the available resources at your disposal. Once you have prioritized your ideas and built the blueprint to implement them, you can add to it as more resources become available.

Development of tactics. Set up each of your priorities with a timeline, and write it down. But be sure to constantly review and assess your progress.

Generation of metrics. Let’s face it: Most academic leaders are scientists, and scientists like data. Once you have developed a business plan based on your vision, strategic plan, priorities, and tactics, as in a clinical protocol, be prepared to measure what you have accomplished, including whether you have met your objectives, endpoints, and assumptions for success or failure.

“Know what you want, have vision, listen to others, and seek advice, but ultimately—especially in a tense situation—take the reins and lead.

— Daniel F. Hayes, MD, FACP, FASCO

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4. When you are recruited for a new position, or when you recruit someone to a new position, there are three critical elements to keep in mind for success. I’m not sure who said this, but I’ve found these elements helpful:

Responsibility. Know what the job entails. Don’t let anyone tell you “titles are not important.” They are, in fact, essential to success. Good will from your boss, although helpful and good to have, won’t make you or your recruits successful. Knowing what your boss expects of you, or what you expect from the staff you are recruiting, will help you avoid serious problems in the future.

Authority. Ask yourself, “What authority do I or my recruit have to ensure that our vision is executed successfully?” If you lack the authority behind the title you were given, you will get nothing done.

Resources. Will you get, or give, the resources to accomplish your vision once you have been given the responsibility and authority to do so? If not, run, don’t walk, away from the deal.

5. Growth happens continuously; administrators think incrementally. Credit me. If you lead or direct a program that requires resources, you’ll outgrow whatever you were given, so ask for more than you need upfront, and outfox your administrative boss.

6. Do not give young people enough rope to hang themselves. Credit me. I cannot tell you how often I’ve seen bright, young, ambitious fellows or faculty members see “greener pastures” in a new job offer only to learn later that way too much is expected of them, and they soon burn out. The best advice I ever received when I was starting my career came from my faculty leaders at Dana-Farber Cancer Institute, George P. Canellos, MD, and Robert J. Mayer, MD, who said, “If you think you’re getting impressive offers now, wait 5 years and you won’t believe what you’ll be offered after you’ve actually accomplished something!”

7. The hardest part about being a resident is not being an intern. Credit me. Don’t micromanage your staff. Learn to delegate responsibilities to trusted individuals, and then let them fulfill those responsibilities.

“Don’t micromanage your staff. Learn to
delegate responsibilities to trusted individuals, and then let them fulfill those responsibilities.”

— Daniel F. Hayes, MD, FACP, FASCO

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Science

8. Challenge dogma. Credit I. Craig Henderson, MD, Adjunct Professor in the Department of Medicine at the University of California, San Francisco, my clinical and research mentor when I was a fellow and who continues to mentor me today. I will never forget Dr. Henderson asking, “Why are academics so dogmatic? The whole point of being an academic is to challenge what we think we know.” As a breast cancer oncologist, I constantly sing the praises of the surgeons from the 1960s, including Bernard Fisher, MD, and Umberto Veronesi, MD, among others, who challenged the Halstedian dogma of aggressive breast surgery passed down through the decades. Beyond courageous, they changed many paradigms in how we treat breast cancer and improved care for patients. We should all strive to be like them.

9. Luck is not a good strategy in golf or science. Credit me. It’s important to recognize good luck when it happens, but one cannot count on being lucky in life. For success in research, plan your laboratory or clinical experiments carefully, and don’t just hope you’ll get lucky. This pearl of wisdom is particularly relevant to tumor biomarker studies, in which so many investigators pull specimens out of a freezer, run an assay, put the results together with clinical outcomes, see some interesting data, and then ask themselves, “What was the question?”

10. Appreciate good luck when you get it, and be flexible. Credit numerous people. We wouldn’t have penicillin if Scottish physician-scientist Alexander Fleming, FRS, FRSE, FRCS, had thrown away his bacterial plates because the ongoing experiments were ruined by mold dripping on them. It’s important to stay focused, but be prepared to change course if necessary.

11. Plant lots of seeds, and see which ones grow. Credit the many farmers surrounding Shelbyville, Indiana, where I grew up. Although in academia one needs to stay modestly focused, clear-cutting a forest and planting all the same tree species is a game plan for disaster. This pearl has served me well in science. I have tried to stay focused in my work, but not so much on one issue that if it fails, I have nothing else to do.

“I will never forget Dr. Henderson asking,
‘Why are academics so dogmatic? The whole point of being an academic is to challenge what we think we know.’”

— Daniel F. Hayes, MD, FACP, FASCO

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12. Challenge your own study results (part 1), or don’t trust anyone who never publishes negative results. Credit me. I’m proud of having published several papers in which the reported study was a good idea, but the results didn’t bear out the hypothesis. When a fabulous hypothesis that I have developed is not supported by the data, I think of a phrase so often used in NASCAR racing: “That’s racing” or, in our world, “That’s science.”

13. Challenge your own study results (part 2), or maintain a sense of humility about your research findings. Credit Baruj Benacerraf, MD, a Nobel Laureate and President of the Dana-Farber Cancer Institute during the 1980s and 1990s. Dr. Benacerraf said, and I’m paraphrasing, “If it [your study results] is really good, someone else will tell you.”

14. Think like a physician/think like a scientist. Credit me, from lessons I’ve learned from my many mentors. At the end of every clinic day, there should be an important question to address scientifically, and at the end of every research day, there should be a clinical application to your study findings. This exercise is the epitome of translational research. Don’t write a research paper just to get promoted. Ask yourself, “So what? What do these results mean?” and think about how the results, positive or negative, might be applied to your patients’ care.

15. The hallmarks of a good clinical trial are the questions it has raised. Credit Dr. Fisher, Former Chair of the National Surgical Adjuvant Breast and Bowel Project. Don’t just walk away from your last laboratory or clinical experiment; use the result to design the next one.

16. A bad tumor marker is as bad as a bad drug. Credit me. As a second-year fellow, my mentor, Donald W. Kufe, MD, of Dana-Farber Cancer Institute, handed me a suite of monoclonal hybridomas and challenged me to find a circulating marker for breast cancer. I did find it, and it turned out to be CA15-3, which is now used worldwide to monitor patients with metastatic breast cancer. However, at the time, I assumed that, as with new drug development, there must be rules for the development and introduction of a tumor biomarker into the clinic. I was mistaken. I got lucky with CA15-3, but I’ve made many mistakes in the field. Ultimately, I’ve learned that we need to be as rigorous with the diagnostics we use to guide our treatment strategies as we are with the treatments themselves.

17. When it comes to medicine, there is no distinction between “scientist” and “clinician.” Credit Dr. Henderson. There are basic scientists, translational scientists, and clinical scientists. Each one rigorously uses the scientific method to play an important role in understanding the biology of disease and translating research to improve clinical care. Don’t let anyone speak of “the scientists” and “the clinicians” as separate entities at your institution. Defend this turf!

Patient Care

18. Never talk a surgeon into performing surgery, a radiation oncologist into giving radiotherapy, or an airplane pilot into flying. Credit me. These folks love to do what they do, so listen very carefully when they offer cautionary recommendations.

19. No patient wants to be a great case (because that means you don’t know how to treat the patient) and no patient is a great case (he or she is a person whose case happens to be interesting to you). Credit Donald W. Seldin, MD, who died recently, but who, for decades, had been the Chairman of the Department of Medicine at what is now The University of Texas Southwestern Medical Center, including while I was a resident. During our morning reports, Dr. Seldin would admonish us for being enthusiastic about a “great case” and explain that patients with serious illnesses are scared and trust that we will do our best to care for them with compassion. It was okay to learn from these patients, but not to think of them as “cases.” To this day, I think of my patients as “patients,” not “cases,” and that keeps me grounded.

“Patients and their family members can
become emotional, irrational, and even
confrontational. If you respond in kind,
it only escalates the situation.”

— Daniel F. Hayes, MD, FACP, FASCO

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20. Don’t go home until you’ve returned phone messages from patients, their family members, or their physicians. Credit Dr. Canellos. Patients are anxious to learn what their test results show or their next plan for care. Don’t keep them waiting.

21. Think of every patient as your relative and treat him or her with the same care and respect you would accord a family member. Credit Gloria Smith, a nurse practitioner with whom I worked during my mid-career, who taught me more about patient care than my mentors.

22. You should deal rationally with irrational people, including patients and their family members. Credit me. Patients and their families are often scared and may be uninformed or poorly informed about their cancer and its treatment; they can become emotional, irrational, and even confrontational. If you respond in kind, it escalates the situation. Engaging in rational, logical, and respectful discussions can usually resolve a negative situation.

23. The patient has cancer, you don’t. Credit my father, Robert E. Hayes, a businessman, and my personal experience. This pearl echoes Dad’s motto that “the customer is always right.” As stated earlier, justifiably, patients and their family members can become emotional, irrational, and even confrontational. If you respond in kind, it only escalates the situation. Rational, logical, and respectful discussions usually—but not always—resolve such situations. They also help the staff act accordingly. I’ve tried to instill in our staff that they are the face of our institution and that first impressions are usually the lasting ones. We all need to make patients feel confident they have chosen the right cancer center. It is our job to always be friendly, compassionate, and helpful.

Administration

24. If there’s no blood involved, most crises take care of themselves. Credit Dr. Henderson. What this means is, unless it really is a crisis, some delay in addressing it won’t hurt. Rather, stay focused on what you’re doing, and get the job done.

25. Make it easy to do right and hard to do wrong. Credit Elizabeth Hammond, MD, a pathologist at Intermountain Health Care in Salt Lake City and my long-time compatriot in improving tumor biomarker tests. Careful planning is required to deal with the propensity for human error in any task, and it is amazing to see how often this pearl is broken by hospital administrators. The clumsy integration of electronic health records in medical institutions over the past decade is a classic example of what not to do.

26. Challenge the statement “This will only take a minute” at any meeting you attend. Credit Dr. Henderson. Dr. Henderson always made the point that almost every committee is formed to settle some grievous sentinel event. However, most committees continue to meet even after the problem is solved and are compelled to take action to solve other problems, often with the proviso that “this will only take a minute.” But over time, those minutes add up. Fight the urge to get drawn into these encounters.

“Don’t overreach and think you can do
something you’re not trained to do or, worse, not capable of doing or don’t have the time to complete.”

— Daniel F. Hayes, MD, FACP, FASCO

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General Behavior

27. If your desk is cleared when you go home at night, you’re not doing enough. Credit Dr. Henderson. I’ve always loved this one. My perpetually messy desk would please Dr. Henderson, since it suggests I’ve managed to keep busy over the past 35 years!

28. If you’re just showing up at work and are not passionate about what you are doing, think of something else to do. Credit (I think) Emil Frei III, MD, one of the fathers of our field and a trailblazer in the use of combination chemotherapy. I don’t know if he ever slept, but we never saw him idle or not thinking about the next potential cure for cancer.

29. Even when you’re on the right track, if you don’t keep moving, you’ll get run over. Credit American humorist Will Rogers.

30. Give yourself 24 hours to mope over a rejected paper or grant, and then get back to work. Credit Dr. Kufe. I’ve always loved this pearl. It’s gotten me through several crushing defeats.

31. Know yourself. Credit all of us, but in particular, Laurence J. Peter, who formulated the Peter Principle, an observation that in a hierarchy, people tend to rise to “their level of incompetence.” Don’t overreach and think you can do something you’re not trained to do or, worse, not capable of doing or don’t have the time to complete.

32. Do the unpleasant things in your day first, then do what you like to do. Credit Robert E. Hayes. My father’s point is that putting off unpleasant or disagreeable tasks doesn’t make them less unpleasant or less disagreeable, so get them done early.

33. Don’t be selfish. Credit Dr. Canellos. Your students’, fellows’, lab technicians’, postdoctoral fellows’, mentees’, or colleagues’ success is your success. During his ASCO Presidential Address, Dr. Canellos said, “My greatest clinical trial results are the fellows I have trained.” What he meant is that mentoring was as meaningful to the advancement of medicine as his own research contributions. I hope my trainees recognize that I feel the same way.

34. Talk with someone you respect who is not in medicine or science. Credit Jane Hayes, my wife, best friend, and confidante. She has a way of seeing how ridiculous we can be, and she lets me know what is really important in any decision.

35. Behave with integrity, honesty, and respect for others. Credit my mother and father, Betsy R. and Robert E. Hayes. They were both lost to cancer over a decade ago, and I hope I’ve made them proud.

Acknowledgments: I would like to thank all of the mentors and colleagues I have quoted in this piece for both their wisdom and generosity. I would like to especially acknowledge Dr. Joseph Simone, who was very gracious with his time and comments in preparation of this piece. Finally, I want to acknowledge Dr. Donald W. Seldin, who died at the age of 97 on April 25, 2018. He will be sorely missed by the generations of medical students and internal medicine residents he trained and inspired. ■

DISCLOSURE: Dr. Hayes owns stock in Oncimmune LLC, and Inbiomotion, is a consultant/advisor for Cepheid without compensation, is principal or co-investigor of sponsored clinical research for Merrimack Pharmaceuticals, Inc (Parexel International), Eli Lilly and Company, Menarini/Silicon Biosystems Veridex (Johnson & Johnson), Puma Biotechnology, Inc (subcontract Washington University, St. Louis, to University of Michigan), Pfizer, and AstraZeneca, and has received royalties from licensed technology from Janssen R&D (Johnson & Johnson).